Download - Chapter Eight Technical Skills CHAPTER EIGHT

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Chapter Eight | Technical Skills

Student Workbook © 1975 – 2017 The Mandt System, Inc.

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OverviewThis chapter is focused on de-escalating potentially aggressive situations so that restraint is not needed. The skills taught are intended to be for “low arousal,” which means the interaction between the caregiver and the individual receiving services involves minimal contact and minimal force and is of minimal duration. In this way, an individual’s autonomic nervous system will be less likely to signal body systems that the actions of caregivers pose a threat of harm.

When instructing caregivers who have been taught in another program, be prepared to take more time! It is more difficult to unlearn a skill and then learn a new skill than it is to just learn a new skill. If the organization has recently switched to The Mandt System®, it will take approximately 1½ times as long to teach each of the technical (physical) chapters. Caregivers have been told that the previous program would maintain their safety and the safety of others, and now they are being told something else. People will need time to vent and express their fear, frustration, anxiety, and tension. Honor their concerns! Instructors may have experienced similar concerns at the time of their initial certification. Allow opportunities to vent and share information on how to resolve those concerns.

Turn-Step: This skill provides a method to move a person away from someone they may be aggressive toward, or it can help the caregiver move away from the person if the person is perceived as aggressive toward them. It also provides the bridge between the principles presented in Chapter Seven and the technique of restraint if restraint is needed. This is the most important skill taught in this chapter! If people can develop a high skill level in turn-step, releases from other holds may not be needed. See Chapter Nine for information on assessing whether or not a restraint may be needed.

Physical Releases: As you teach this section, remind people of the Five A’s. If someone grabs for attention or affection, the program plan and/or R.A.D.A.R. will inform as to whether or not there is a need to gain release. If someone grabs for assistance, never gain release! You may cause them to fall. If a person grabs for aggressive purposes, pay close attention to the assessment stage of R.A.D.A.R.. If someone grabs because they are afraid, use R.A.D.A.R. to assess the situation, attempt to de-escalate and reassure the individual, and try to determine what the cause of the fear might be. If someone is becoming aggressive, it is not wise to use both hands to try to gain the release as there is no way to protect from aggression. Instead, use stance and balance, body mechanics and movement, and body positioning to either be outside the reach of the person’s other hand, or be close and, if possible, behind them.

Learning Objectives Upon completion of this chapter, participants will have:

1. Explained the Five A’s of why people may grab you or others.

2. Defined immediate risk of harm.

3. Identified the seven concepts of physical interaction.

4. Distinguished between situations requiring physical release and those that could be resolved through non-physical release.

5. Explained how Maslow, R.A.D.A.R., and the crisis cycle apply in releases.

6. Demonstrated the use of each of the physical skills presented in this chapter.

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SODAS

SODAS model of conflict resolution (physical)

In Chapter Three, Healthy Conflict Management Skills, the SODAS model was introduced as a problem solving method. Apply the same approach to the use of restrictive physical interaction skills.

The SODAS physical model is suggested when the conflict with the person has escalated to a level where physical interaction is necessary. All of the underlying philosophy and theory taught in the non-physical model still applies. The SODAS physical model is a set of strategies used for people who have very low thresholds for frustration and stress. Aggression and violence from the person has created a situation that threatens the safety of the person(s) involved in the interaction.

Assessing danger or threat

The following information will help with the assessment process:

1. Is there a believable threat of harm to self and/or others? Many organizations using The Mandt System® serve individuals who make threats that are not believable. In many cases, they are “posturing behaviors” where people make statements that are designed to maintain their safety by appearing threatening to others.

Some individuals make threats that mimic or replicate verbal behavior they see and or hear used by others on television or in movies. Questions to ask may be:

• Has the person made threats in the past that were not carried out?

• What is the tone of voice of the person?

• What does their body language say about the believability of the threat?

2. Is the person capable of carrying out the threat of harm? Some of the individuals make threats that are believable, but the person does not have the physical capacity to cause harm.

Questions to ask may be:

• How old is the person? Generally speaking, children under seven years old do not have the physical capacity to hurt an adult. They may have the capacity to cause injury to other individuals.

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• What is the history of the individual?

• What is the physical capacity of the individual?

• Are they affected by a physical disability that may limit their range of motion, use of limbs, etc.?

3. Is the threat of harm immediate? Is there something else that can be done besides moving closer to the person and touching them? If there are other options, it may be reasonable to try those before physical interaction.

When people see a dog standing with its teeth showing, saliva dripping down its jaws and growling, how do they typically respond? If a cat has its back arched, hair standing on end, hissing, what is being conveyed by its communication?

In both cases, the animals are communicating that they want distance (Lindsay 2005, Bradshaw 2013). The neurological structures of all mammals are very similar, especially in the lower parts of the brain where threat perception and response are housed. When humans use communication to attempt to gain distance between themselves and a perceived threat, caregivers should respond by backing up slightly in a nonthreatening stance, ensuring their hands are open and nonthreatening. When people communicate they want distance, their R.A.D.A.R. will be on you. It’s a dance, the person leads and caregivers follow. Backing up is not backing down. It gives people the space they need to feel safer.

If the answer to any of the questions is “no,” further assessment with the person is needed, recognizing that the perception of the person’s ability to carry out a threat or to make a believable threat may not be accurate. Perception checking skills (Chapter Three) are important tools, as is teamwork (Chapter One).

If the answer is “yes” to the three questions, then it may be reasonable to use physical skills to prevent harm to people involved in the interaction. This is called a clear and present danger. Keep in mind the goal is to de-escalate the person(s) as safely and quickly as possible.

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This will not be possible if caregivers fail to manage themselves first. Remember, the caregiver is part of the interaction. Once it has been decided that the threat (behavior) presents a clear and present danger to people, it is important to act and act quickly. Use both physical and non-physical skills to help the person move from crisis to de-escalation as quickly and safely as possible, using the least amount of interaction necessary for safety.

After attempting non-physical methods for de-escalation of the crisis, the SODAS physical model is used as a guide through the conflict. This model will examine:

• Situations

• Options

• Advantages

• Disadvantages

• Solutions

The situation is that the behavior of an individual poses a threat of harm to themselves and/or others.

Non-physical interaction has been attempted, but has not been effective in assuring the safety of everyone present.

Options are then reviewed by the caregiver, in line with the graded and gradual system of alternatives (Chapter One). Remember that there are three responses discussed as part of the R.A.D.A.R. model: non-physical, general physical responses, and specific physical responses. Can the caregiver move out of the way, and/or verbally direct others out of the way? Can the caregiver use redirection or deflection skills, or can they use one of the releases taught in Chapter Eight? There are a number of physical interventions that are less invasive and intrusive than restraint.

Evaluate the advantages and disadvantages of each option relative to the risk for injury (evaluate risk).

Help the caregivers and the other person select solutions (stop the physical interaction).

The purpose of the SODAS model is to enhance the safety of all people within the environment. Do so by empowering the person to exercise reasonable control over their environment. When people feel they have control, their perception of safety is increased. This also helps to regain self-respect, establish trust with caregivers, and can help develop effective ways of coping with troubling situations in the future.

To frame the difference between immediate and imminent threat of harm, the following information from John S. Harper with the Florida Department of Children and Families (Harper, 2010) has been adopted by The Mandt System®:

Time Frame Immediate Imminent Open-ended

Definitions A safety threat- not separated in time, acting or happening at once, next in order

The likelihood of severe harm that may occur in the near future; impending

Consequences High Risk Moderate Risk Low Risk

Conditions Severe out of control

Serious problematic

Troublesome

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Why we teach releases

When caregivers are in a situation where someone has grabbed their wrists or clothing, many of them feel an immediate sense of fear and as a result enter the fight or flight continuum. This process of escalation could result in a coercive reaction, “Let me go!” or a quick physical action to get away that may actually cause more harm to the person and/or the caregiver.

By teaching simple, easy-to-remember techniques to gain release, caregivers can apply what was taught in Chapter One, Affirm your feelings and choose your behaviors™. When people feel safe, they act safe, and this includes caregivers. By having a sense of competence and confidence in physical skills, caregivers can give non-physical methods of gaining release more time to work, remain centered on their own values and beliefs, and interact with individuals receiving services with dignity, respect, patience, trust, and forgiveness.

The five A’s

The five A’s explain the reasons why people may grab and hold on to someone.

Based on anecdotal evidence and class discussion, The Mandt System® believes there are five basic reasons for human-to-human contact. They are, in order of perceived frequency:

Affection — While communicating, many people use touch as a means of showing they care about the individual. There are cultural differences around touch as communication, as some cultures have almost no physical contact while communicating, while others have almost constant physical contact while communicating.

Assistance — Requests for assistance are the second reason people may initiate physical contact. The need for assistance may be non-physical, or it may be physical if someone is losing their balance.

Attention — Sometimes people, especially children, will want to show something to others, or may want to have the person focus on them.

Afraid — People often grab others when they are afraid. Examples include grabbing the person who is about to draw your blood or the person sitting next to you on an airplane.

Aggression — Based on a review of incident reports, aggression towards others was the least frequent reason for physical contact.

If caregivers respond to all physical contact as if it were aggressive, they will end up cueing aggressive behavior! Pay attention to the individual before they make physical contact to assess the reason behind their

behavior, and consider if you really want to gain a release.

One of the most important concepts to understand is this: The hand that is holding is not the hand with the potential to hurt, except in the case of hair pulling and bending fingers back.

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Physical Interaction Concepts In The Mandt System® approach, the purpose of the skills taught in Chapter Eight is to facilitate the process of de-escalation. In previous chapters there was an emphasis on inviting people to de-escalate, and at the point at which the skills of this chapter are needed, the person may not have heard the invitation or rejected the invitation for some reason. It will be important then, for the caregivers to manage themselves by affirming their feelings and choosing their behaviors.

The physical skills taught in The Mandt System® are designed to use movements that are small and smooth, as the person has their R.A.D.A.R. on the caregiver. The person is assessing how threatening the caregiver’s actions are. Chapter Two presented the idea that “Their R.A.D.A.R. is on you,” meaning that when people have escalated, they are using their R.A.D.A.R. to determine if it is safe to de-escalate. The instruction has organized these physical interaction concepts in a way that increases the likelihood that people will accept the invitation to de-escalate that is offered to them. Ensuring that movements are small and smooth will help caregivers appear less dangerous to others.

Speed and motion

In order to accomplish the movements described in this chapter, elbows must be in close to the body (with the exception of the bite release). With hands open, use slow, small, and

smooth movements, keeping everyone on balance.

It is important to do the skills slowly and as smoothly as possible to gain a release. If the skills are performed fast and/or with large movements, this may startle the other person and they may become afraid or confused and try to strike back. Also, time to escalate may make them hold on more tightly or grab in a different, perhaps worse, place.

Note: If the person being held is experiencing pain, movements will need to be quicker, but remaining smooth and small.

It is important to always be concerned about how others are interpreting the caregiver’s physical movements. If in gaining a release, the caregiver’s physical presence and body language look aggressive (e.g., hand balled up in a fist or hand high up in the air above their shoulder), the other person, or someone else watching, may misinterpret their actions and think the caregiver is trying to physically attack or abuse the person whom they are trying to assist. Keep hands open so the person being served can see light coming through the fingers. This kind of hand appears to be much less threatening than a hand that is open but with fingers close together.

When the caregiver is relaxed it provides a better chance to think through options. It will also convey to the other person that the caregiver is not going to overreact or hurt them. If the caregiver is relaxed, this may

cause the other person to relax and feel safer, which provides a better chance of gaining a release from the hold.

If, while a release is being sought, the person holding thinks there is an intent to hurt them, in most cases individuals will react in a different manner than if they do not think they will be hurt. Ask yourself how you would react if you were in the same position.

It is important to note that at no time should a caregiver use thumb or finger “come-along,” “crank,” or grab (i.e., hyper-extension of joints, pressure points, or pain techniques). Those types of techniques are prohibited by The Mandt System® and are a violation of the individual’s rights and abuse policies. At no time should any techniques like those be used.

Always keep everyone balanced. If the other person is off balance, they, as well as the caregiver, have a chance of falling down. This means that either or both parties could get hurt.

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Real time versus psychological time

Also consider real time versus psychological time. The principle of “real time or psychological time” in an incident where help is needed is the difference between the actual time it took to get help by the clock (e.g., 30 seconds), and the time perceived to get help (e.g., 10 minutes).

When people are under stress, time has a way of speeding up or slowing down. An actual time frame of 10 minutes, for example, may seem like a few seconds or may seem like half an hour.

In Chapter Four, Trauma Informed Services, a model by Dr. Bruce Perry was presented that showed how psychological time narrowed and sped up as stress increased. Remember when people receiving services

escalate, are experiencing similar effects in the conflict between psychological time and real time.

To make slow, smooth, and small movements, the caregiver will need to de-escalate first and operate on real time, not psychological time. If most people are given 10, 20 or 30 minutes of real time to de-escalate, it also gives caregivers time to de-escalate. In some cases, the caregiver may need the time to de-escalate more as they may unintentionally be contributing to the problem.

Examples:

Action — An individual served, whose past aggressive behavior has resulted in injury to others, begins to pace, glower at the caregiver, and make threats. One of the caregivers nonchalantly makes a call for a third caregiver to join them.

Reaction — Because it feels like it is taking forever for the other caregivers to arrive, the caregivers who are present decide that they had better get into a position so if the person attacks, they can defend themselves. In the process of moving, the caregivers look at each other anxiously and the individual served picks up on their anxiety and attacks

Action — Two individuals are arguing with each other. One of them wants to disengage, but the other person keeps moving closer. The caregiver is busy completing necessary forms for end-of-shift report and says “I’ll be with you in a minute.”

Reaction — The individual who wants to escape escalates 10 seconds later because help did not arrive immediately.

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Voice/vocal tones/ paralanguage

While interacting with people physically, remember to also interact with them verbally. People will be assessing the caregiver’s tone of voice, volume, and the sounds they are making.

Use shorter sentences, speak more slowly, and keep hand gestures to a minimum. In the section on the vocal elements in communication, these aspects were stressed, as well as when speaking with someone whose primary form of communication is nonverbal. These concepts are applicable in this section as well.

Distance

This section deals with situations in which people have moved

into the caregiver’s intimate space. After gaining release, the caregiver is encouraged to step back slightly, making sure to keep hands up. Being too close to someone may increase their own sense of being threatened.

Touch

Chapter Two, Healthy Communication Skills, taught that physical contact can be used to communicate in either a positive or a negative way. Touch is a very subjective thing. People who have experienced significant trauma may respond differently to touch than others. The caregiver may be using physical touch in order to provide safety, but they are also communicating. Remember this while going through the chapters in the technical section.

Principles of touching:

1. Ask permission to touch whenever possible or say “Excuse me for touching” if unable to ask permission. If working with a small child, ask the child as well as the parent. If the person cannot communicate for himself, ask him and the person who communicates for him. Some people do not like to be touched at all and generally have the right not to be touched.

People who have been abused or who are injured may be particularly sensitive to touch. Touching the person without permission may cause the person to move higher into the crisis cycle, causing them to become aggressive and try to hurt the caregiver, themselves, or others.

2. Know how to touch. Sometimes when emotions are high, caregivers unwisely touch. Think before acting. Will touching help the person reach their goals? Is the caregiver trying to get the person’s attention or give positive feedback? Touch may be necessary when talking to young children or others who need messages to be reinforced

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by other senses in order to receive the communication.

People who are hyperactive or easily distracted may need the caregiver to touch their hand or shoulder and maintain eye contact while giving them verbal instructions. Make sure the touch is relaxed and nonthreatening.

Also, remember that similar physical contact with adolescents or people who have been abused may be interpreted as a threat. For people with sensory integration issues, light touch may be perceived as aversive.

3. Where to touch someone will depend on how they are holding the caregiver. Think of this as a “dance—they lead, and the caregiver follows. Specific instructions on where the hand should be placed will be given later in the chapter.

4. Relax and touch slowly to avoid startling and confusing the person. The caregiver communicates many things about themselves merely by tensing or relaxing their body. If they relax when touching, it will let the other person know that the caregiver does not intend to overreact or hurt them. It may be necessary to move more quickly when in pain, such as when people are being bitten or hair is being pulled.

5. Keep hands open and relaxed. Be concerned with how that touch may look and feel to the person with whom the

caregiver is interacting and others who may be watching. If the use of physical space and body language feels and looks aggressive, or if the hands are up and in fists, people may interpret the actions as an attempt to attack, intimidate, or abuse the person.

6. Touch for as short a period as possible. When people are under stress, one’s perception of time may be distorted (speeding up or slowing down). A good guideline is to let go as soon as it is no longer necessary to touch.

Tense or relax is another concept of the speed and motion section. Someone may grab the caregiver because they may be losing their balance, or they are feeling faint, confused, or upset. It is a natural reaction to tense, but to de-escalate a person, the best response is to try to relax.

When the caregiver is grabbed by someone, that person is telling them many things by the manner in which they grabbed the caregiver and how firmly they are holding. In the same way, the caregiver passes messages when holding on to another person, or by the way the caregiver reacts when being grabbed or held by someone else.

When a caregiver is grabbed, they often feel unsafe and the natural reaction is to tense their body. When the caregiver feels safer, their response is to relax. They will feel safest when they have competence and confidence in their skills and in the plan.

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Examples

Other person to the caregiver:

Action: Person grabs the caregiver by the wrist and starts to squeeze or is squeezing tightly.

Conveys: The person may start to become or is already confused, angry, afraid, trying to hurt the caregiver, or trying to get the caregiver’s attention.

Action: Person relaxes the grip or hold.

Conveys: The person is starting to de-escalate and is not as angry, afraid, or confused, and is not trying to hurt the caregiver.

Caregiver to the other person:

Action: The caregiver gets tense or becomes rigid when the other person grabs or holds onto them (e.g., wrist, arm, shoulder, clothing).

Conveys: The caregiver is afraid, becoming angry or starting to get upset.

or

Action: The caregiver touches or starts to hold the other person, squeezing tightly.

Conveys: Either the caregiver is angry, in a power play, upset, excited, afraid, or may not know their own strength.

If the person starts to feel physical pain because of being held too tightly, they may start to escalate. Relax, maintain balance, and observe what else is happening in the environment. If assistance is needed, ask for it.

Pain will escalate people — physical pain and emotional pain.

When people are in crisis and experiencing any kind of pain (physical or emotional), certain body responses increase such as blood pressure, pulse, breathing, muscle tension, and the body’s production of adrenaline and endorphins. People may also start to talk faster and louder. They may use the language of pain (profanity).

Please review the crisis cycle to better understand how pain escalates people under stress. In order to avoid unnecessarily escalating a person, it is critical to apply the concepts learned in the preceding section about “tense or relax.”

Attempt to remove the cause of the pain. Be an active listener. Don’t fake attention or ignore the person. Try to empathize. Observe the person’s nonverbal cues (e.g., appearance, facial expression, eye contact, body language, personal space), as well as their verbal cues (e.g., tone, pitch, resonance, speed, breath, volume, and message). Practice with co-workers using interpersonal communication and physical role play.

It is important to note that at no

time should a caregiver ever use any of the following: pain and pressure points (whether

for brief or extended

periods); joint or

skin torsion (twisting/turning in opposite directions); pressure or weight on chest, lungs, sternum, diaphragm, back, abdomen, neck, throat, soft parts of the body; hyperextension (pushing or pulling any part of the body, limbs, joints, fingers, thumbs, or neck beyond normal limits in any direction), e.g., holding one or both arms behind the back and applying pressure, pulling or lifting. The concept that pain will de-escalate a person is false. All of these actions are prohibited in a number of states such as Wisconsin, Minnesota, Washington, Maine, and Missouri. A complete list of states and service sectors which prohibit such actions is available in the Instructor Resource Center.

Pain does not de-escalate anyone.

Pain (physical or emotional) should never be used to make a person comply with directions or demands. It is abuse and it will destroy therapeutic treatment and rapport between the person and the caregiver. Most people, when they are in pain, try to move away from that pain as fast as they can. Most people do not and will not just stand there and let someone hurt them if they can help it. When people are in pain, they may:

• Become more aggressive to caregiver, now or later

• Become more aggressive toward another caregiver

• Become aggressive toward another individual served

• Become aggressive toward property (TV, room)

• Become self-abusive

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Stance and balance

Proper stance and balance permit safe and smooth movements when working with people who may need some assistance.

Body mechanics and movement

Muscle groups

The three concepts of stance and balance, body mechanics and movement, and body positioning are also the way to understand the importance of using muscle groups working together. The key point of muscle groups (muscles helping other muscles) comes into play whenever anything physical is attempted. People use muscles to lift, to move, and to do many other things. When you use muscle groups you don’t need as much strength, movements may be smoother, and it is more likely to gain a smooth and relaxed release.

Without muscle groups, people would be severely limited in the amount of work they could do and the strength with which they could do it. As an example, here are a few of the muscle groups that are activated from the ground up when attempting to gain a release from a wrist hold.

To help maintain balance and have a strong stance, use the foot, ankle, calf, thigh, hip, abdomen, and torso. To help gain a release from the wrist hold, use the wrist, forearm, bicep, shoulder, chest, and back. Upper body strength is enhanced when elbows are in close to the body. With one exception, the bite release,

when using physical skills in The Mandt System® caregivers will always keep their elbows in. All of these groups must work together to gain a smooth and relaxed release.

In order for all muscle groups to work together, stress the importance of being in the right stance in order to maintain enough balance for both people if they lose their balance. Anytime someone loses their balance, their need for safety increases as well as their fear of falling. In order to prevent escalation from occurring, make sure people are safe and balanced.

The weak point

The weak point is the final element under the concept of body mechanics. The weak point allows the person to gain the release without using as much force as would be required if there were no weak point.

The key thing to do in any type of hold is to ask, “Where is the weak point of the hold?” The weak point identifies where it will be easiest to try to gain a physical release from the hold. In gaining a release from any type of hold, work with the weak point, between the THUMB and FINGERS when grasping an object with one hand.

Body positioning

Body positioning describes where the caregiver’s body is in relationship to the other person. It is important for the caregiver to know if they should be on the left or right side of the person or whether or not to change sides.

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Separating

Non-physical separating

Gaining a non-physical release is getting out of a physical hold without using a physical skill. It is not always necessary to use a physical means of release. There are times when the easiest way to gain a release from any type of hold is to ask the person to let go. The first goal is to try some non-physical ways of release. Using one of the non-physical means listed below may be the best approach after initially interacting or acknowledging the person:

Relax — If the caregiver’s body is relaxed when the other person holds on to them, they will feel that the caregiver is relaxed and almost always relax as well. When the caregiver tenses up, they will almost always tense up as well.

Ask the person to let go — Sometimes that is all that is needed!

Tell them that they are holding on too tightly — When the caregiver tells the person they are holding on too tightly, they are recognizing the person and the person’s actions in a way that invites the person to de-escalate if the caregiver’s tone of voice is nondemanding.

Use diversion and/or distraction — May be useful tools in such a situation. Make sure to treat the person with respect, and don’t lie (such as pointing and saying “your shoe is untied” when it is not).

Ignore the behavior, focus on the person — Ignoring the behavior and focusing on the

person validate who they are, without inadvertently reinforcing what they are doing. Remember, it was taught earlier that attention was a behavior, not a reinforcer. If someone grabs for attention, they often want something other than attention. It could be they need someone to talk with them or to help them feel safe, or they may need your assistance.

Focus on both the person and the behavior — Depending on the quality of the relationship with the person, this could be a good option. If the person receiving services trusts the caregiver, the caregiver can ask them what they want. Again, tone of voice will be an important factor in using this or any approach to invite the person to de-escalate.

Separating

Separating may involve any of the following skills:

• Avoiding is eluding, evading or escaping physical contact through the use of body positioning, shifting, stepping, or sliding, without making physical contact with the person.

• Redirecting or deflecting is, while avoiding, using the hand and/or arm to make physical contact without holding on to the person.

• Releasing is removing someone or something from a physical hold and may involve holding on briefly to the hand and the wrist of the person.

In the execution of the responses, never assume that the caregiver’s first response will satisfy the situation. Rather, continuing a constant alertness (R.A.D.A.R.) will enable safety to be promoted throughout the interaction. Always have a “Plan B” available in case the first response is not effective at ensuring the safety of all people.S

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Key concepts of separatingThings to consider before separating

• RELAX!

• Ask!

• Look!

• Hurting?

• Can you wait?

• Why do you want to get away?

• What is person telling you?

• Don’t overreact!

• Don’t fight force with force!

• Know your limitations and the limitations of this course.

- RELAX because if the person being held relaxes, the person holding may relax as well.

- Ask the person to let go.

- Look at what the person is doing. How is the person holding you, another person, or an object?

- Is the person hurting you or someone else or holding too tightly?

- Do you have to gain a release or separate the person from someone else right now, or can you wait a few seconds?

- Why do you want to get away or separate the person from the object or someone else? Is it really that important or does it just seem that way?

- What is the person assessing by the way the caregivers tense or relax their bodies when being held?

- Use the graded system of interaction. Don’t overreact. This is evidenced by the caregiver’s physical presence and nonverbal and verbal skills.

- Don’t fight force with force. Redirect, don’t resist, the person’s actions.

- Caregivers need to know their limitations and the limitations of this course. The caregiver cannot be all things to all people, and in the same way, not all physical skills will work on all people. Differences in height, mass, and physical skill level may interact to increase or decrease the effectiveness the interventions used. Because pressure points, pain, hyper-extension, and other practices are prohibited, instructors need to learn how to support caregivers taking this workshop to keep themselves and other people safe by always assessing themselves first.

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Four reasons it won’t work• Wrong number of people

This usually means too many people trying to talk to the person at once, but it may also mean not enough people to meet the safety needs of everyone involved in an incident or crisis situation.

• Wrong size of caregivers

This may mean a smaller person is outweighed or out-sized by a larger person.

However, it is generally easier for a smaller person to work with a larger person than the other way around. Size differential must be taken into account, and there is a need for a practical understanding of physical limitations.

• Wrong gender

People with trauma histories are especially at risk for being retraumatized by someone who reminds them of the person who abused them. Also, in some settings, women can more easily de-escalate situations than men can, because of many of the elements of physical presence discussed in Chapter Two.

• Wrong attitude

This is the most common reason people may say, “This stuff won’t work.” Any tool can be used to build up or to tear down. The skills taught in the Technical Skills Section will be most effective if paired with the concepts, principles, and philosophy contained in the Relational Skills Section. If people have an attitude that someone has to pay for what they did, or receive an immediate punishment to “teach them a lesson,” then that attitude will not work and it is not using the philosophy of The Mandt System®.

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S.2R.A.D.A.R. & physical interaction

This chapter teaches physical skills to respond to situations in which an individual has grabbed and is holding on to the caregiver or another. Prevention is much more effective than intervention! To prevent, encourage students to keep their R.A.D.A.R. on.

RECOGNIZE: Be aware of what “normal” looks, feels, and sounds like. Be aware of the current situation with baseline data. Be aware of the history of behavior, if any. There is a truism: The best predictor of future behavior is past behavior. If the person has a history of hair pulling, biting, or other aggressive actions, be aware of body positioning, distance, and other factors.

ASSESS: Use information from the assessments done for IEPs, behavior plans, treatment plans,

or other plans. Know as much as possible about the person’s trauma history and patterns of behavior under stress. Be aware of formal and informal assessments. Assess using the skills taught in Chapter One.

DECIDE: If there is a plan addressing behavioral concerns, it will lay out specific steps for caregivers. This is the “decision” in terms of how best to respond to the person. If there is no plan, follow the principles taught throughout The Mandt System®, making sure to avoid all prohibited practices. Look for prevention and/or intervention strategies. Never assume the caregiver’s first response will satisfy the needs of the situation. The goal is to keep everyone safe! Have “Plan B” ready to go if “Plan A” does not work.

ACT: The decision comes to life now, and is implemented.

REVIEW RESULTS: Were the goals and outcomes hoped for actually achieved? If so, the person should begin to de-escalate. Follow the principles taught in the crisis cycle. Use R.A.D.A.R. to support the person and others.

When using R.A.D.A.R., remember to use active and reflective listening skills taught in Chapter Two. One of the things that can help assess where the individual is at the moment is to ask “Are you safe?” or “Are you ok?” Using a gentle, empathetic tone of voice will help to convey the desire to have them share their feelings which may help them to de-escalate.

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Turn-StepThis is the most important skill taught in this chapter! See the discussion earlier in this chapter about the importance of the turn-step. The turn-step skill is a prerequisite for all separating skills.

Application: There are times when a person may be coming toward you and your R.A.D.A.R. has told you they do not need your assistance or attention. You may not want them to make contact with you, but rather to move past you. This application combines the principles of stance and balance, body mechanics and movement, and body positioning.

Mechanics:

1. Person A walks toward Person B with her right hand open and reaching for the person’s chest area.

2. Person B has both hands up in a nonthreatening position with hands close together, thumbs touching, elbows in close to the body, and feet in a natural stance.

3. Person B steps back onto the right foot into a stance appropriate for his body size.

4. Person B avoids, as much as possible, the arm of Person A, and holds his hands above and below the elbow, as Person A goes past him. If physical contact is needed to deflect for safety, with thumbs touching, Person A places one hand above and one hand below the elbow of the person served. If Person B makes physical contact, he says, “Excuse my touch.”

5. Person B keeps his hands up in a nonthreatening position, and continues to use non-physical skills to help the Person A de-escalate.

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Notes:

(A)(B)

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Alternative skill:

1. Person A walks toward Person B with her right hand open and reaching for the person’s chest area.

2. Person B has both hands up in a nonthreatening position with hands close together, thumbs touching, feet in a natural stance.

3. Person B steps forward with his left foot into a stance appropriate for his body size.

4. Person B avoids, as much as possible, the arm of Person A, holding his hands above and below the elbow, as Person A goes past them. If physical contact is needed to deflect for safety, with thumbs touching, Person B places one hand above and one hand below the elbow of the person served.

5. Person B keeps his hands up in a nonthreatening position, and continues to use non-physical skills to help the person de-escalate.

Discontinuing the skill: Keep your R.A.D.A.R. on! You will need to decide whether to maintain your distance from the person or step closer based on the assessment discussed in the SODAS method as applied to physical interaction.

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Alternative skill example:

Notes:

(A)

(B)

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Physical Releases

Key fundamentals of releasing

In all releases, there are three key steps that will be followed

1. Establish a stance that will allow for proper body mechanics. The proper stance, typically, will allow the person doing the release to have their elbows fall as close as possible below the ball joints of the shoulders on the same side. The stance should also be wide enough that both feet remain flat on the floor throughout the entire process of the release. Once the stance is established, there should be very little movement of the feet other than slight adjustments for balance. The stance should also allow for functional movement of the “core” of the person doing the release. The core part of the body is the area just below the belly button and just above the knees.

2. Identify the weak point and, if necessary, anchor while making an alignment for possible release. Almost all weak points will be the opposite direction of the large knuckles of the hand that is doing the holding.

Exception: One exception to this concept would be when the hand doing the holding has completely created a cylinder around what they are holding. An example would be fingers or some objects. The weak point in a “cylinder” release is either out of the top or from the bottom of the hand that is doing the holding.

In almost all situations, it is safest to the individual doing the holding and for the caregiver to establish an anchor point on the hand/wrist area that is doing the holding. Every effort should be, while anchoring, to put the soft tissue of the caregiver’s anchor hand onto the soft tissue of the wrist/hand area of the person doing the holding; avoiding direct contact with joint and bone as much as possible. If a proper stance has been established, then the anchor should allow the caregiver’s hand to anchor the palm side of the hand doing the holding while maintaining the caregiver’s elbows below the joint of the same side shoulder or as close into the body as safely allowable for the situation. When separating someone from somebody else,

not only will there be an anchor of the wrist during the holding, but the caregiver’s other hand will anchor an area of the person being held no further than eight inches away from the area being held.

3. Make a movement of a muscle group to gain the release. If your stance has a foot forward, the rotation of the core will be toward the back foot across the front of your body. The rotation should allow for the elbows of the person gaining the release to remain as close as possible to the rib cage on the same side as their shoulders, next to their body. If the stance is a natural or side stance, the muscle group movement will be either to move the large knuckles of the hand doing the holding away from what they are holding or move what is being held away from the large knuckles. No matter what the movement is to gain the release, it should come from a muscle group while both feet remain firmly on the ground.

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Release by rotating your hand and arm toward your body

If someone has grabbed you with one hand, it is imperative that you keep your R.A.D.A.R. on and watch for the other hand. To teach the concepts needed to gain release, this material is presented as if someone grabbed you. Pay attention to the principles!

Application: This is most appropriate when R.A.D.A.R. indicates a person will not let go of your wrist without some action on your part. Someone has grabbed you or someone else. In order to gain a release yourself, or assist someone else, you will need to assess how they are holding on:

• Where is the weak point?

• How much force is being used?

• Where are they in the crisis cycle?

• Where is the other person in the crisis cycle?

• How are they holding?

Possible causes: The caregiver has attempted to gain a release non-physically and was unsuccessful, but decided to physically gain a release or help someone else gain release.

Mechanics:

1. When a person holds (shakes) your right wrist with their left hand (their thumb is on top of your wrist and their fingers are on the bottom), step forward into a natural stance. Make sure you are close enough to place your elbow on the front part of your ribs and abdomen. This puts you in a better position to use muscle groups. Relax your arm.

2. Rotate your wrist 1/4 of a turn to the inside of your body (palm down) to open the weak point. Point your right thumb to your left elbow if your right wrist is being held. Rotate your hips in the direction your thumb is pointing to assist you in gaining a release. At the same time that you rotate your wrist to the inside, you will move your right hand to your left elbow in a slow, small smooth manner with just enough movement to gain a release.

Note: While doing this, make sure you keep your elbow down and in, so that you can maintain the muscle group concept to help you gain the release. Don’t move your feet until you have gained a release.

3. To gain more distance, step backward, making sure you face the person and move in a relaxed manner, using your verbal communication skills as well as your body language to help de-escalate the person and yourself. Your hands should be open and look nonthreatening.

Caution: Be aware of the person you are interacting with and their past history, if possible. Make every effort to maintain eye contact, if appropriate. Ask the person to let go. Remember to breathe, relax your hand and arm, and be willing to go with the person, if they are moving you around. Ask yourself, “Must I really get away, or does it just seem that way?” and “Is this person really hurting me?”

Discontinuing the release: Make sure that the person holding you, as well as the caregivers present, feel safe. Always be concerned about the individual’s balance and safety. Remain facing the person and continue to monitor and de-escalate yourself and the situation.

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Release by rotating your hand and arm away from body

Possible causes: The caregiver has attempted to gain a release non-physically and was unsuccessful, but has decided to physically gain a release.

Application: When someone grabs your wrist or arm, another very simple way to gain a physical release is to move your wrist or arm to the outside of your body. No matter how the person is holding you, the concept of the weak point remains the same.

Mechanics (First, rotate/Second, pull):

1. When a person holds (shakes) your left wrist with their left hand (thumb on top of your wrist and fingers on the bottom) make sure you are close enough to place your elbow on the front part of your ribs and abdomen. This puts you in a better position to use muscle groups. Relax your arm.

2. Rotate your wrist 1/4 of a turn to the outside of your body, palm up. Point your left thumb to the outside of your body, At the same time you rotate your wrist to the outside, you will move your hand to your left in a sweeping, circular motion with just enough movement to gain a release, making sure you do it in a slow, small smooth manner. Rotate your hips in the direction your thumb is pointing to. Don’t move your feet until you have gained a release.

3. To gain more distance, step backward, making sure you face the person and move in a relaxed manner, using your verbal communication skills as well as your body language to help de-escalate the person and yourself. Your hands should be open and look nonthreatening.

Caution: Be aware of the person you are interacting with and their past history, if possible. Make every effort to maintain eye contact, if appropriate. Ask the person to let go. Remember to breathe, relax your hand and arm, and be willing to go with the person if they are moving you around. Ask yourself, “Must I really get away, or does it just seem that way?” and “Is this person really hurting me?”


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Release from clothing holds

Application: This is most appropriate when R.A.D.A.R. indicates a person will not let go of your clothing without some action on your part. A person grabs your clothing with one or two hands. They may or may not be trying to hurt you. You can either let them hang on to you while you talk or you can try to gain a physical release. Know the individuals you are working with. Attempt to determine why they are holding on to you. Determine if you need to be released immediately or if it is possible to wait.

Possible causes: The person may be trying to get your attention, grabbing hold of you for safety, afraid, needing reassurance or assistance, or may be trying to hurt you..

Mechanics:

Remember to ask the person to let go and/or ask them what they want or need before beginning any attempt for a physical release.

Shirt sleeve

1. If the person grabs the sleeve on your right arm with their left hand, ask the person to let go. Say “Excuse me for touching” when unable to ask. Anchor your arm by holding it very close to your body. Stepping forward with your left foot, place your left hand on their wrist and palm area. It is a good practice whenever possible to put your thumb in the palm of the hand of the person doing the holding to provide additional support.

2. Move the material out until all the slack is gone, and complete a short, quick pop using your leg/hip and arm for leverage, moving their hand in the direction the large knuckles are pointing and moving your shoulder back slightly at the same time.

Shoulder

3. If the person grabs the clothing on the top of your right shoulder with their left hand, ask the person to let go. Say “Excuse me for touching” when unable to ask. Make sure your stance is appropriate for your body size. Take your left hand and grasp your clothing about eight inches from their hand (i.e., on the palm side of the person’s hand) in order to anchor your shirt.

4. Use your right hand to grasp as much of their left hand and wrist area as you can. Think in terms of a waiter carrying a tray. If a waiter carries a tray with their right hand, they carry it on the right side. Look for the weak point or the weak area of the hold. Which way are their large knuckles pointing?

5. Gain a physical release by using a short, quick movement:

A. Pull the fabric out, in the opposite direction their large knuckles are pointing (up, down, to your left, or to your right), or…

B. Move their hand (pop the hand off) in the direction their large knuckles are pointing (up, down, to your left, or to your right), or…

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C. Pull the fabric out, in the opposite direction their large knuckles are pointing (up, down, to your left, or to your right), or…

Do “A” and “B” at the same time.

Note: Not everyone has the body type to do this but it is a good practice, whenever possible, to put your thumb in the palm of the hand of the person doing the holding to provide additional support.

Caution: If their fingers are intertwined in the material and you pop the hand too fast, you could break their fingers. If the person has gotten their hands underneath an undershirt, bra strap or belt, there is no weak point and you will need to use non-physical methods of gaining a release.

Release their hand and move away, or you may maintain a hold on their wrist or forearm if you desire to do any follow-up skills, i.e., assisting, redirecting, or restraining (as a last resort), or you may let go and step away. Remain facing the person. Continue to monitor and de-escalate yourself and the situation.

Note: The same release may be used if someone is holding on to your shoulder, upper arm, or sleeve. There are many types of clothing holds and it is essential that the responses described in this section be practiced with a partner. In the beginning, the practice should be very carefully regulated by performing the necessary movements in slow motion until the exact performance is completely understood. By gradually increasing the speed of your response as your training partner grabs, you will build an automatic response. Frequent practice a few minutes a day, several days a week, will aid this development.

Caution: Be aware of the person you are interacting with and their past history, if possible. Make every effort to maintain eye contact, if appropriate. Ask the person to let go. Remember to breathe, relax your hand and arm, and be willing to go with the person if they are moving you around. Ask yourself, “Must I really get away, or does it just seem that way?” and “Is this person really hurting me?”

Assess the reason the person has grabbed you. If it is for aggression, be aware that during the time you are using your free hand, you will be vulnerable to aggressive action! It may be more effective to not try to gain release and use your stance and balance, body mechanics and movement, and body positioning to either move away from the person, out of their reach, or move closer to them and, if possible, to their side or slightly behind them.

Discontinuing the release: Make sure that the person holding you, as well as the others present, feel safe. Always be concerned about the individual’s balance and safety. Remain facing the person and continue to monitor and de-escalate yourself and the situation.

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Release from finger holds

Application: This is most appropriate when R.A.D.A.R. indicates that a person will not let go of your fingers without some action on your part. When someone grabs your fingers, their goal could be to gain your attention or to cause you pain or discomfort. Although now it is your fingers being held rather than your wrist, the concept of the weak point remains the same.

Possible cause: A person walks up and grabs your finger(s). Because fingers are easy to break, you want to gain a release as soon as possible.

Mechanics:

1. The person has grabbed your two fingers with their right hand.

2. Ask the person to please let go. Say “Excuse me for touching” when unable to ask permission. Step up and get your elbows in. Take your free hand and place it on their hand and wrist area. The heel of your left hand rests on the large knuckles of the person’s right hand. This will help stabilize and support the hand and wrist of the person bending your fingers and will help you gain a release. Follow their movements, maintaining body alignment so that the fingers are not bent back and injured. Ask the person again to let go.

3. Place your right thumb on your left hand (of the hand where the fingers are being held) and push down with your left hand, locking your left elbow. Use your right thumb as a pry bar on your left hand. This will aid you when you slowly pull your fingers out of the grip.

4. Simultaneously, move their hand back, down, and away while you pull your fingers out, making sure you pull as slowly as you can. You may choose to move your finger pads into the person’s fingers or the palm of the hand, depending on which hand the person is using. This will give your fingers more support and leverage when gaining a release.

Caution: Let the arm, wrist, and fingers relax. When fingers are tense they are easy to break. Follow their movement, maintaining body alignment. Do not twist your fingers. Use interpersonal communication skills to continue to de-escalate the individual.

Assess the reason the person has grabbed you. If it is for aggression, be aware that during the time you are using your free hand, you will be vulnerable to aggressive action! It may be more effective to not try to gain release and use your stance and balance, body mechanics and movement, and body positioning to either move away from the person, out of their reach, or move closer to them and, if possible, on their side or slightly behind them.


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Release from biting

Application: This is most appropriate when R.A.D.A.R. indicates that a person is slightly elevated in the crisis cycle and the likelihood of them causing serious injury to themselves or someone else (intentionally or unintentionally) is imminent. There are two basic types of bites: the small-mouth bite, in which the front teeth are used, and the large-mouth bite, where all of the teeth are used. Both hurt! The person who is biting may have no teeth, or loose and decayed teeth. Even if the person who is biting has only a few teeth or no teeth, a bite with the gums can cause pain and can transmit diseases.

Never use pressure points or pain or attempt to force the arm into a person’s mouth in an effort to force the jaw open. (The jaw has a hinge on each side, which will break or dislocate if forced open too widely.)

Key points about biting:

• At no point should you ever try to use any pain compliance techniques, joint twisting, or hyper-extension of joints to gain a release.

• Reduce the pain and slowly remove the part that is being bitten from the person’s mouth.

• Report all bites and get medical treatment as soon as you can.

Biting themselves—possible causes: People bite themselves, generally speaking, for neurosensory reasons, or to inflict pain on others when they feel powerless to do anything else. This skill may be practiced by biting yourself or with the assistance of others.

Mechanics:

1. The person is biting themselves. Approach the individual and ask them to stop biting and to open their mouth.

2. If the individual refuses to cooperate, move behind the individual and by moving your body very close and supporting their head with your shoulder, lightly anchor the person’s head to your shoulder. This provides leverage when you attempt to move the jaw down. Never move the person’s head to your shoulder, always move your shoulder to their head!

3. Place the soft parts of your hand, the web areas between your thumb and your fingers or your first two fingers, on the person’s chin bone in preparation for moving the jaw down. Depending on body size/body type, the your hand can go between the forearm and upper arm of the person to place the soft parts of your hand on their jaw, or your hand can reach for the chin area of the individual in front of the arm of the individual.

4. Push down using firm, slow, and gentle pressure on the chin. The mouth will open. Then move the bitten area out.

5. Report all bites and seek medical attention.

The jaw hinges downward, so slowly with an open hand, push the jaw down. As the jaw moves down, move the bitten area out. Redirect the person’s arm if they try to bite again, or you may choose to physically restrain the individual to prevent them from harming themselves. Follow the individualized plan.

Note: If you are the person being bitten, after the pain to the bitten area is reduced, you are safe, and you become less angry and less afraid, you will have a much better chance of de-escalating the person who is biting you or biting themselves. It is very important to affirm your feelings and choose your behaviors, to think through the process, and to be able to judge your various alternatives, depending

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upon what the other person is doing. You must de-escalate yourself first. In situations in which the person is biting others, apply the same principles of stabilizing the person’s head, moving the jaw down, and moving the bitten area out.

Report all bites, and get medical treatment as soon as you can. Follow the most current medical procedures for bites and for safeguarding against the transmission of diseases through bites. Remember, several diseases can be transmitted from one person to another through blood, saliva, and bacteria, especially if the skin is broken on the person who is being bitten, or if the person who is biting has open sores or bleeding in their mouth.

Discontinuing the release: Make sure that the person being released, as well as the others present, feels safe. Always be concerned about the individual’s balance and safety.

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Release from hair pulling

Application: There are two basic types of hair pulling: hair being pulled from the front and hair being pulled from the back. Both can hurt! After the pain to the head is reduced, you feel safer, and you become less angry and less afraid, you will have a much better chance of de-escalating the person who pulled your hair. It is very important to affirm your feelings and choose your behavior, to think through the process, and to be able to judge your various alternatives, depending upon what the other person is doing. You may become frightened by the hair pulling, a feeling which can manifest itself in the emotion of anger. Whether the result is fear, pain, or both, it is important to remember that the key point in hair pulling is to reduce the pain.

Key points about hair pulling:

At no point should you ever try to use any pain compliance techniques, joint twisting, or hyperextension of joints to gain a release. Hair pulling may not be lifethreatening, but it could cause physical injury to the scalp, neck, or spine.

Reduce the pain to the person’s head. Depending upon the threshold of pain, the hair pulling may not hurt.

The person who is pulling hair is usually very upset (afraid, angry, confused). If you try to cause pain to make the person stop, it may not work, may be considered abuse, and may result in the person becoming more aggressive.

Hair pulling from the front

Possible causes: You are having your hair pulled by an angry individual. The person may have been denied privileges or may be angry with someone else. For whatever reason, they pull your hair.

Mechanics

1. An individual that you provide services for has grabbed your hair and is causing you to be fearful and experience a great deal of pain. Grasp the person’s forearm with both hands, thumbs and fingers encircling the wrist. Bring their hand close to your head, neck, or ear. Ask the person to let go and say “Excuse me for touching.”

2. Hold their hand tight to your head, neck, or ear to help to reduce any pain to your head. If they pull you around, move with them, keeping your back straight. Go with it; don’t try to resist. In some cases you may need to have your second hand free to intervene if the person tries to scratch, hit, or pull more hair. When you feel the person’s forearm relax, or when the person has stopped pushing or pulling you around, you may consider trying to gain a release.

If the hair is being pulled from the front you may attempt to gain a release by using a short quick pop. Remember to keep yourself focused on protecting yourself and the other person. Keep talking to the person and ask them to let go, if it is appropriate.

Discontinuing the release: Make sure that the person being released, as well as the others present, feel safe. Always be concerned about the individual’s balance and safety. Remain facing the person, and continue to monitor and de-escalate yourself and the situation.

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Hair pulling from the back

Application: To gain a physical release, if your hair is being pulled from the back, use one hand to maintain a grasp on their forearm, holding it firmly close to your ear or neck. With your other hand, grasp your hair in small strands and slowly pull it out a little bit at a time.

Possible causes: You are having your hair pulled by an angry individual. If someone grabs hair with one or two hands, immediately try to reduce the pain, stabilizing their hands so they cannot pull away and by going with the person if they are pulling you around. After you and the other person are calm, have someone help you gain a release. You have a much better chance of gaining a release by yourself if you have short hair.

Mechanics:

1. An individual has grabbed your hair with their right hand from the back.

2. Drop your left shoulder and turn to face the person. Grasp the person’s forearm with both hands, thumbs and fingers encircling the wrist. Have thumbs and fingers encircling the wrist and move their hand close to your head, reducing the pain. Move with the person, if they pull you around, making sure you keep a good stance and maintain your balance. Go with it; don’t try to resist. After you feel safer and have de-escalated, talk to the person and ask them to let go, if it is appropriate.

If the person uses both hands to pull your hair, you can use both of your hands and hold the person’s forearms/wrists firmly to your head. When you feel the person’s forearm relax, or when the person is changing direction while pushing or pulling, that is the time you can try to gain a release. If your hair is long, you may need assistance for another individual.

Caution: Remember the goal in hair pulling is to reduce the pain, not to necessarily get away. Move with the person. Use good body mechanics. Never fight force with force. Always remember our goal is to de-escalate the individual and protect them from harm. Treat the person with dignity and respect.

Discontinuing the release: Make sure that the person being released, as well as the others present, feel safe. Always be concerned about the individual’s balance and safety. Remain facing the person, and continue to monitor and de-escalate yourself and the situation.

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Head butting

Application: If someone grabs your hair with both hands from the front, hold both of their hands with both of your hands, at but not above the wrist. Make sure you are in a front stance and that your belt buckle is pointed to the person. If they try to pull your hair, keep their hands close to your head. If they try to head butt, they will almost always put their head back and then move toward you. As they move toward you, take a small shuffle step (step and slide) backward so their head cannot make contact. Use your verbal skills to ask “yes questions” such as “Are you ok?,” “Do you hurt?” and “Are you safe?”

Mechanics

If needed, you can hold on to their right hand with your left hand, and use your right arm to protect yourself using the following steps:

1. Raise your right arm so your elbow is above your right ear. Use the part of your arm with the bicep muscle to secure their left hand.

2. Bend your arm so your right hand, palm out, is at your forehead. This will put the fleshy, inside portion of your arm facing the person. If they headbutt you, they will hit this part of your arm. NOTE: If your palm is in, they may hit the part of your arm that has a bone near the surface, which could result in significant harm to you.

3. Make sure you are in a front stance, right foot forward, with belt buckle facing the person.

4. Use your verbal skills to ask “yes questions” such as “Are you ok?,” “Do you hurt?” and “Are you safe?.”

Kicking while pulling hair

Application: If someone grabs your hair with both hands from the front, hold both of their hands with both of your hands, at but not above the wrist. Make sure you are in a front stance and that your belt buckle is pointed toward the person. If they try to pull your hair, keep their hands close to your head

Caution: If they try to kick, remember that the back leg is the one that will be kicking. Stand in a mirror position. In other words, if their left foot is back, your left foot should be forward so if they do kick, you can take the kick in your thigh/buttocks area instead of the groin area.

As you are standing with them, use your verbal skills to ask “yes questions” such as “Are you ok?,” “Do you hurt?” and “Are you safe?”

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Separating two people when safety is at riskWhen two or more individuals served are engaging in verbal aggression towards each other, the most important thing to do is to separate them, because as long as the stimulus is in front of them, they will continue to escalate. They are each other’s stimulus!

To do this, use a combination of nonverbal and verbal strategies presented in Chapters Two, Three, and Seven. If you are alone, one of the assessment questions is whether or not you need help, and if so, when help might arrive. In some settings, particularly correctional programs, individuals served have conspired with each other to fight, so the caregiver physically engages with them, and then the individuals overpower the caregiver, get the keys, and so on.

FOLLOW THE POLICIES AND PROCEDURES OF YOUR ORGANIZATION IN MAKING THE DECISION ABOUT HOW TO ADDRESS THIS SITUATION.

If the individuals served are physically fighting each other, you know that at least one of them is at the top of the crisis cycle. You will need to ask yourself some additional questions to determine how to respond to this situation.

How are they fighting? Are they circling each other and throwing occasional blows, or are they continuously attacking?

Does one of the individuals appear as if they want help in getting away?

Does one of the individuals trust you? Will the person listen to you even though they are upset? If so, perhaps you can talk to this person and ask them to leave.

Is there a behavior support plan, IEP, treatment plan, or other plan that may provide you with a guide for how to respond?

You will need to address these questions along with the other questions in the assessment portion of R.A.D.A.R.. The three questions posed at the beginning of this section are (1) Is there a believable threat of harm?; (2) Is the person capable of carrying out the threat?; and (3) Is the threat of harm immediate? Physical interaction may be warranted only when the answers to all three questions are “YES.”

If you are working with other caregivers, you will need to practice teamwork drills to know which caregiver will work with specific individuals, how you will respond, who goes first, and other logistics. It will be important to have nonverbal cues that you can use, such as code words.

When people are fighting each other and they have not “locked up” with each other, use the turn-step skill to separate them.

If they have locked up with each other, you will need to assess how they are grabbing each other. If they have grabbed clothing or are holding on to an arm, wrist, or other part of the body, you will need to assess where the weak point is and which hand should be released first.

When you are trying to help others gain release using physical interaction, remember the principles:

• Use your nonverbal skills!

• Use your verbal skills!

• Ask the person to let go.

• Use diversion and distraction, and always keep your elbows in!

• Your hands should be near, but not on, a wrist joint to provide stability when you are helping someone else gain a release.

• RELAX! If you look and sound tense, the other people will escalate!

• Be aware of your stance so you can shift quickly.

• Keep yourself and the other people on balance.

• Avoid all of the prohibited practices.

• Never try to rotate someone’s wrist area to gain a release.

• If someone’s hair is being pulled, stabilize. Do not attempt to gain a release.

• Know your limitations and the limitations of this course.

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Separating fundamentals appliedTwo people separating two people

1. Two people are facing each other and both are holding on to each other’s bicep/triceps area of the arms.

2. Two caregivers assess the situation. One caregiver approaches from one side while the other approaches from the opposite side.

3. Each caregiver must assess whose arm is to the outside or safest to separate first. If the person whose arm is to the outside is on the left of the caregiver approaching, the caregiver will approach and anchor by placing their right hand on the arm of the person being held and the right hand on the wrist doing the holding. They will, at the same time, get into a stance that allows them to maintain balance while keeping their elbows in close. While anchoring the arm being held with their right hand, the caregiver will determine the direction of the large knuckles of the hand doing the holding (weak point). If the knuckles are facing out, the caregiver, while holding the grabbing hand and maintaining their elbows into the sides as close

to their body as possible, will rotate their hips and shoulders to the left and gain the release.

4. Next, while maintaining a hold of the person’s (to their left) right wrist with their left hand, the caregiver will slide their right hand down to the left wrist of the person who is to their right. The caregivers at the same time will be making the necessary stance adjustments to maintain balance and body mechanics for optimal muscle groups. They will determine the weak point by looking at the direction of the large knuckles of the left hand of the person to their right. Then, with a quick pop in the direction of the large knuckles, they will move the person’s (to their right) left wrist up and away from the person they were holding.

5. Once both caregivers have gained all the necessary releases and are maintaining the wrists of both individuals, they should attempt to remove the visual stimulus, by each caregiver assisting one of the individuals to a different area. This should be done according to the plan/communications while using

R.A.D.A.R. to determine safest approach. If each caregiver is to take the individual to their left, they will start by releasing the hand they are holding with the right hand. While maintaining the right wrist of the individual to their left, the caregiver will take their right hand and move it to above the right elbow with four fingers to the outside, thumb to the inside. The caregiver will then step through the center of the two individuals while releasing with their left and placing the left hand on the left waist/belt line of the person to their left. The caregiver will safely move the individual to the least restrictive place to maintain safety and start the de-escalation process. Throughout the entire process of release, a graded systems approach should be used to safely separate and remove stimuli by first asking people to release and move to where they would be safe. If the individuals are holding each other in any other way than previously described, the three fundamentals of releasing must be applied (connecting the dots) to safely gain the separation.

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Separating ergonomic assessmentThe following section reviews each of the skills taught by The Mandt System® and reviews how The Mandt System® maximizes safety and minimizes risk in each of the skills. As stated before, no physical skill can be considered “safe” as there is a risk of injury anytime physical interaction takes place.

We are indebted to Chris Van Ee, Ph.D., whose biomechanical assessments of all the physical skills taught by The Mandt System® were used in completing this assessment. David H. Mandt, Sr., was the primary architect of all of the physical skills taught by The Mandt System® with additional input from the faculty of The Mandt System, Inc.

In some regulations, the skills taught in this chapter are called “escape and evasion” skills. In teaching these, The Mandt System® continues to build on the three principles of stance and balance, body mechanics and movement, and body positioning taught in Chapter Eight. The goal of the skills taught in this chapter is to provide for the safety of all people in circumstances that

could be aggressive. In order to provide this safety, key principles in the application of body mechanics in this chapter have been identified.

Releases (wrist, clothing, fingers)

The weak point is between the fingers and the thumb of the person who is holding on to you, someone else, or something else. In The Mandt System® we teach that it is never appropriate to cause pain or discomfort, which will occur if we try to pry the fingers or thumbs off, or rotate against the thumb.

Safety is maintained by ensuring that movements are slow, smooth, and relaxed, which serves to maintain the balance of all people. Touch is maintained for the shortest period possible, and as soon as safety is established, physical contact between the people who have gained release will end.

When gaining release, the caregiver assesses the situation and decides whether or not

release should be gained at all. If release must be gained, physical interaction is used after non-physical interaction has been demonstrated to be ineffective at ensuring the safety of everyone involved. If a release must be gained, caregivers decide if they can gain the release without using their “free hand.” Using the free hand increases the balance of the individual served, but it may put the caregiver at greater risk of harm. If the behavior of the individual is deemed to be aggressive, gaining release by using a free hand may not be advisable.

If physical interaction is used, caregivers will again assess and decide if they can gain release without using the “free hand.” The use of muscle groups minimizes the need for force to be used, and the combination of stance and balance, body mechanics and movement, and body positioning will combine to maintain the safety of all involved. The movements in each of the skills have been designed to maximize safety by minimizing risk.

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Wrist release

Safety of the individual receiving services — Contact between the individual served and caregiver is minimal on the part of the caregiver. Movements of caregivers to gain release are designed to be slow with hands open and relaxed. When contact is made between the caregiver and individual served, the contact is brief and is designed to maximize safety and minimize discomfort. If the caregiver believes the individual may be off balance, this skill is not recommended. By using muscle groups, the caregiver uses a minimum amount of force to gain release.

Safety of the caregivers — The caregiver maintains awareness of the intent of the individual by using their R.A.D.A.R. as taught in Chapter One of The Mandt System®. Caregivers maintain their balance by using the stance appropriate to body size and body type. By using muscle groups, caregivers use a minimum amount of force to gain release.

Caution — The individual served may squeeze too tightly and cause pain to the caregiver. If the caregiver does not adjust their stance, and the individual served moves, there is a potential for wrist, elbow, and/or shoulder dislocation. If the caregiver does not use muscle groups and tries to gain a release, they may cause the person to become off balance and fall. If the caregiver does not rotate their wrist so the thin part is at the weak point of the hold, they may cause wrist, elbow, and/or shoulder dislocation. All steps of the skill must be followed to increase safety for all people.

Clothing release

Safety of the Individual receiving services — When individuals served grab the clothing of a caregiver and the caregiver chooses to gain release, the safety of the individual is maintained by the caregiver using slow and short movements to maintain the balance of the individual. By using muscle groups, the caregiver uses a minimum amount of force, which lowers the risk of harm to the individual. Contact between the caregiver and the individual served is only for a brief period of time and is designed to minimize discomfort by stabilizing the wrist, not grabbing the wrist or any other joint, and releasing contact with the individual as soon as release is gained.

Safety of the caregivers — Safety of the caregivers is maintained by the stance the caregivers use and by maintaining an awareness of the intent of the individual using the R.A.D.A.R. of the caregiver. Movements are slow, and by using muscle groups, the use of force is minimized. When contact is made between the caregiver and individual served, the contact is brief and is designed to maximize safety and minimize discomfort. If the behavior of the individual is determined to be aggressive, the caregiver will need to assess whether allowing the individual to maintain the clothing hold is safer than gaining release.

Finger release

Safety of the individual receiving services — The point of contact between the caregiver and individual served is on the back of

the hand which is holding on to the fingers of the caregiver. The individual’s balance is maintained by the position of the caregiver relative to the individual and by minimizing the amount of force needed to gain release through the use of muscle groups.

Safety of the caregivers — Safety of the caregivers is maintained by the stance the caregiver uses and by the caregiver maintaining an awareness of the intent of the individual by using R.A.D.A.R. Movements are slow, and by using muscle groups, the use of force is minimized. When contact is made between the caregiver and individual served, the contact is brief and is designed to maximize safety and minimize discomfort. Because the caregiver is relaxed, pain and discomfort are minimized and the use of the free hand stabilizes both persons and provides a fulcrum to facilitate release.

Hair pulling from the front

Safety of the individual receiving services — The hand placement of the caregiver at, but not on, the wrist minimizes discomfort for the individual. By not placing the caregiver’s hand above the wrist, individuals served do not experience pain when their hand is held close to the head of the caregiver. The front stance of the caregiver provides balance for both the caregiver and the individual served.

Safety of the caregivers — By stabilizing the hand of the individual served and holding it close to the head, pain and discomfort are minimized.

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The front stance provides the caregiver with the balance needed to move with the person, if necessary. Holding the elbows in close to the body provides for safety if the free hand of the individual served attempts to strike the caregiver’s face.

Hair pulling from the back

Safety of the individual receiving services — The hand placement of the caregiver at, but not on, the wrist minimizes discomfort for the individual. By not placing the caregiver’s hand above the wrist, individuals served do not experience pain when their hand is held close to the head of the caregiver. The front stance of the caregiver provides balance for both the caregiver and the individual served.

Safety of the caregivers — Turning in to the individual empowers the caregiver to see what the individual is doing, so the caregiver can use their R.A.D.A.R. to decide how to respond. By stabilizing the hand of the individual served and holding it close to the head, pain

and discomfort are minimized. The front stance provides the caregiver with the balance needed to move with the person, if necessary. Holding the elbows in close to the body provides for safety if the free hand of the individual served attempts to strike the caregiver’s face.

Bite release

Safety of the individual receiving services — By using only the soft tissue between the thumb and forefingers, or the side of a finger, the comfort of the individual is enhanced. Gentle and steady pressure to open the mouth slightly and not pushing in on the jaw maintains the alignment of the jaw. Focusing on opening the jaw just slightly minimizes discomfort for the individual served. If biting themselves, this skill provides immediate relief from the pain of the bite. When stabilizing the head, place one arm on the top of the shoulder of the individual, as instructed, to maximize their safety.

Safety of the caregivers — Stabilizing the head provides for relief from pain for the

caregiver and minimizes the potential for tissue loss. The front stance provides balance for the caregiver and minimizes the risk of falling.

Separating two people

Safety of the individual receiving services — By working together, two caregivers can ensure the safety of individuals served in situations in which two people may be holding on to each other or trying to strike each other. Caregivers keep their hands off the joints of individuals served and work together to remove the two people from each other’s field of vision. This skill set incorporates the escort skill from Chapter Seven with releases from Chapter Eight.

Safety of the caregivers — Caregiver safety is ensured by working together as a team and quickly assessing the situation together. By each caregiver having one hand on each of the individuals served at all times, caregiver safety is improved. This skill set incorporates the escort skill from Chapter Seven with releases from Chapter Eight.

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ConclusionBefore proceeding to the next chapter, review the learning objectives found at the beginning of this chapter. Do you feel you have accomplished each of the objectives listed? If not, mark the objective(s) about which you feel uncertain and review the section of the lesson that corresponds to that objective. When finished, review the terms listed in the glossary.

Congratulations! You have completed technical Chapter Eight, Separating, of The Mandt System® instruction. We trust this will serve you and those with whom you interact in a way that will enhance the quality of your interactions on a daily basis.

Glossary Of TermsMuscle groups: Muscle groups involve muscles helping muscles in order to accomplish a physical movement.

Real time or psychological time: One’s perception of time (psychological time) becomes distorted when experiencing stress. The real amount of elapsed time may be greater than or less than the perceived amount of elapsed time.

Touch as communication: Physical contact is a powerful means of communication. It can be interpreted in various ways and can cause various reactions.

Weak point: The weak point is the easiest place to gain release from a hold. For example, the weak point in a hold with one hand is between the thumb and fingers.

“Close is safe”: This is a reminder that when a person is swinging an object, there is less power or force when standing next to the person instead of arms-length away.

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Self–Study Guide | Chapter 8

Student Workbook © 1975 – 2017 The Mandt System, Inc.Page A (CH 8 SSG)

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Self–Study Questions

These self–study questions are provided to give you an opportunity to gauge your understanding of these chapters. These questions will be used on the final exam.

Circle the letter(s) beside the correct response(s) to the following questions:

1. People may grab you for attention, assistance, affection, aggression or because they are afraid. Of the five reasons, what is the least likely to be the case? (Ch 8, Pg 220)

a. Assistance

b. Affection

c. Attention

d. Aggression

e. Afraid

2. The weak point is important because: (Ch 8, Pg 226)

a. It lets you know where it may be easier to try to gain a release.

b. Using the weak point will always result in you gaining a release.

c. Using the weak point means you don’t have to use as much force.

3. The concept of muscle groups (muscles helping other muscles) is so important because: (Ch 9, Pg 226)

a. When you use muscle groups, you don’t need as much strength per muscle.

b. When you use muscle groups, your movements may be smoother.

c. When you use muscle groups, you will always succeed.

d. The muscle groups need to work together to gain a smooth and relaxed release.

4. Match the listed separating skill with its definition: (Ch 8, Pg 227)

Skill

a. Avoiding

b. Redirecting

c. Releasing

Definition

Eluding, evading, or escaping physical contact through the use of body positioning, shifting, stepping, or sliding, without making physical contact.

Removing someone or something from a physical hold. This may involve holding on briefly to the hand and wrist of the person.

While avoiding, using the hand and/or arm to make physical contact without holding on to the person.

Complete the following statements using a word from the word bank.

5. Key concepts to determine if you need to gain a release? (List four key points): (Ch 8, Pg 228)

I.

II.

III.

IV.

Word Bank

Don’t fight force with force

Command them to let go

How is the person holding you?

Know your limitations and the limitations of this course

Don’t over-react

Why do you want a release?

Self–Study Guide | Chapter 8

Student Workbook © 1975 – 2017 The Mandt System, Inc. Page B (CH 8 SSG)

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